The Impact of Trauma on Utilization of Primary Care Physician Resources

Abstract

Previous research supports that individuals diagnosed with posttraumatic stress disorder (PTSD) utilize more healthcare resources than those without. This study expands upon this research and fill in important gap, including focusing on a rural and suburban population, using standardized diagnostic measures, investigating both PTSD and unspecified trauma and stressor related disorder, and utilization of primary care physician resources exclusively. Specifically, this study hypothesized that for a rural and suburban patient population, individuals with trauma and stressor related diagnoses would utilize more PCP services prior to diagnoses of their mental health conditions. The study also investigated whether trauma diagnoses are better conceptualized as a predictor or a moderator of utilization. Patient data from a clinic serving rural and suburban individuals was gathered from the electronic medical record. Patient data was gathered from electronic medical records, including demographics, physical and mental health diagnoses, and utilization metrics from a 12-month period prior to a patient encounter in an integrated behavioral health clinic. Utilization variables included (1) total number of PCP visits; (2) total number of laboratory tests ordered; (3) total number of imaging studies ordered; (4) total number of actively prescribed medications, (5) total number of telephone calls, and (6) average complexity/length of visits. A principle component analysis was conducted on the utilization variables to reduce dimensionality, resulting in one principle component of utilization. This component served as the outcome variable in two path analysis models. Results did not support the hypothesis that a trauma diagnosis is a significant predictor of utilization, rather the number of physical health diagnoses emerged as the only significant predictor. Model fit statistics suggested that the moderation model better fit the data. Results may suggest that when access to behavioral health services are present, that physical health is the primary predictor of utilization of PCP services. Limitations of the study include a small sample size and the impact of the COVID-19 pandemic on the data. Future studies may benefit from investigating additional variables that impact utilization, such as adherence to treatment, as well as the relationship between access to mental health services and utilization of PCP services.